A growing number of studies have identified sex differences in response to general anesthesia; however, the underlying neural mechanisms are unclear. The medial preoptic area (MPA), an important sexually dimorphic structure and a critical hub for regulating consciousness transition, is enriched with estrogen receptor alpha (ERα), particularly in neuronal clusters that participate in regulating sleep. We found that male mice were more sensitive to sevoflurane. Pharmacological inhibition of ERα in the MPA abolished the sex differences in sevoflurane anesthesia, in particular by extending the induction time and facilitating emergence in males but not in females. Suppression of ERα in vitro inhibited GABAergic and glutamatergic neurons of the MPA in males but not in females. Furthermore, ERα knockdown in GABAergic neurons of the male MPA was sufficient to eliminate sex differences during sevoflurane anesthesia. Collectively, MPA ERα positively regulates the activity of MPA GABAergic neurons in males but not in females, which contributes to the sex difference of mice in sevoflurane anesthesia.
Anesthesia ; Animals ; Estrogen Receptor alpha/metabolism* ; Female ; Male ; Mice ; Preoptic Area ; Sevoflurane/pharmacology* ; Sex Characteristics

OBJECTIVE：To understand the current status of clinical understanding of “prohibiting”“avoiding”“using caution ” in the application of TCM ，and to provide reference for standardizing the connotation and rational application of “prohibiting” “avoiding”“using caution ”of TCM. METHODS ：Based on the theory of “knowledge-attitude-behavior”，doctor-pharmacist questionnaires and patient questionnaires were designed on the basis of literature research and clinical practice. Through the “Tencent questionnaire ”platform，800 doctor-pharmacist questionnaires were distributed to nearly 300 medical institutions from 32 provinces（cities，autonomous regions ）and 800 patient questionnaires were distributed to public patiants who had used TCM nationwide by anonymous online method. After dimensionality reduction of the questionnaire from three dimensions of cognition ， attention and behavior ，the cognition ，attention and behavior of “prohibiting”“avoiding”“using caution ”in the application of TCM were evaluated by 10 points system. RESULTS ：A total of 703 doctor-pharmacist questionnaires were collected ，including 638 valid questionnaires with recovery rate of 87.9％ and effective rate of 90.8％；Cronbach alpha coefficient was 0.90. A total of 644 patient questionnaires were collected ，including 621 valid questionnaires with recovery rate of 80.5％ and effective rate of 96.4％ . The cognition score of doctors and pharmacists to the terms of “prohibiting”“avoiding”“using caution ”in clinical application of TCM was （7.94±1.21），and that of patients was （5.64±1.54）. The score of doctors and pharmacists ’attention to the above terms was （9.47±1.15）（Spearman Rho correlation coefficient with cognition score was 0.077，P＞0.05），and the score of behavioral ability of patients was （7.01±1.71）（Spearman Rho correlation coefficient with cognition score was －0.021，P＞ 0.05）. The score of behavior ability was （7.43 ± 1.72） （Spearman Rho correlation coefficient with cognition score was 0.233，P＜0.01）. TCM textbooks （89.2％），trainingmeetings （66.5％） and herbal prescriptions （58.2％） were the main ways for doctors and pharmacists to learn the above taboos. Medical staff （74.2％）and internet （52.5％）were the main ways for patients to understand the above taboos. CONCLUSIONS ：Doctors，pharmacists and patients pay more attention to the terms of “prohibiting”“avoiding”“using caution ”in the clinical application of TCM ，but their cognition and executive power were low. Clinical cognition of “prohibiting”“avoiding”“using caution ”in the application of TCM is relatively vague，and the corresponding clinical practice behavior is lacking. It is yet to establish clinical specialist consensus in the field of TCM and publicize it actively to improve the level of clinical rational drug use.

In order to solve the problems of confusion in clinical medication and imperfect instructions in Chinese patent medicines(CPMs), the Standardization Department of the China Association of Chinese Medicine and Center for Pharmacovigilance and Rational use of Chinese Medicine in Beijing University of Chinese Medicine jointly compiled the Instructions for Clinical Application of Chinese Patent Medicines(CPMs). As the interpretation and supplement of drug instruction information, it aims to guide clinical safety and rational use of CPMs. In addition, the technical specification for clinical application description of CPMs has been formulated, which covers the seven processes of "carding instructions, clinical investigation, data retrieval, data screening, evidence classification, path transformation and writing format". It will enable readers of Instructions for Clinical Application of Chinese Patent Medicines to understand the work behind the compilation.
Beijing ; China ; Drugs, Chinese Herbal ; Medicine, Chinese Traditional ; Nonprescription Drugs ; Pharmacovigilance

The lateral hypothalamic area (LHA) plays a pivotal role in regulating consciousness transition, in which orexinergic neurons, GABAergic neurons, and melanin-concentrating hormone neurons are involved. Glutamatergic neurons have a large population in the LHA, but their anesthesia-related effect has not been explored. Here, we found that genetic ablation of LHA glutamatergic neurons shortened the induction time and prolonged the recovery time of isoflurane anesthesia in mice. In contrast, chemogenetic activation of LHA glutamatergic neurons increased the time to anesthesia and decreased the time to recovery. Optogenetic activation of LHA glutamatergic neurons during the maintenance of anesthesia reduced the burst suppression pattern of the electroencephalogram (EEG) and shifted EEG features to an arousal pattern. Photostimulation of LHA glutamatergic projections to the lateral habenula (LHb) also facilitated the emergence from anesthesia and the transition of anesthesia depth to a lighter level. Collectively, LHA glutamatergic neurons and their projections to the LHb regulate anesthetic potency and EEG features.

OBJECTIVE: To investigate the correlation of single nucleotide polymorphisms (SNP) in arachidonate 5-lipoxygenase gene (ALOX5) rs2029253, rs2228064 and rs2228065 sites, 5-lipoxygenase activating protein gene (ALOX5AP) rs10507391, rs4769874 sites with the risk for genesis of adult myeloid leukemia. METHODS: By the approval from the hospital ethics committee and the informed consent of participants. 150 patients with myeloid leukemia (ML) as ML group and 134 healthy people as the control group were selected. The genomic DNA was extracted from the samples. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) combined with directly sequencing, PCR-amplified products were applied to test the polymorphism of 5 sites in ALOX5 and ALOX5AP gene. RESULTS: A allele frequencies of ALOX5 gene rs2029253 site in the ML group and the control group were 43.0% and 34.3%, respectively. And the G allele frequencies in the ML group and the control group were 57.0% and 65.7%, respectively. The genotype distributions of AA, AG and GG in ALOX5 gene rs2029253 site in the ML group were 32.2%, 21.5% and 46.3% respectively. That in the control group were 15.7%, 37.3% and 47.0% respectively. The genotype AA and A allele frequency of ALOX5 gene rs2029253 site were linked with the increased risk of myeloid leukemia (OR=2.26, 95% CI: 1.43-4.56, P＜0.05; OR=1.44, 95% CI: 1.02-2.03, P＜0.05). And the genotype AG and allele G reduced the susceptibility to myeloid leukemia (OR=0.46, 95% CI: 0.27-0.78, P＜0.01; OR=0.69, 95% CI: 0.50-0.98, P＜0.05), however, the polymorphisms of ALOX5 gene rs2228064 and rs2228065 site not correlated with the risk of myeloid leukemia (P＞0.05). The A allele frequency of ALOX5AP gene rs10507391 site in the ML group and the control group were 30.7% and 36.2% respectirely. The genotype distribution rates of AA, AT and TT in ALOX5AP gene rs10507391 site in the ML group was 1.3%, 58.7% and 40.0% respectively, that in the control group were 9.7%, 53.0% and 37.3% respectively. The genotype AA of ALOX5AP gene rs10507391 site correlated with the decreased risk of myeloid leukemia (OR=0.13, 95% CI: 0.03-0.57, P＜0.05), but the polymorphism of ALOX5AP gene rs4769874 site not correlated with the risk of myeloid leukemia (P＞0.05). CONCLUSION The genotype AA, AG and allele A, G of ALOX5 rs2029253, as well as ALOX5AP rs10507391 may be correlate with the susceptibility to myeloid leukemia.

ObjectiveExosomes secreted by BMSC overexpressing GATA-4 gene (BMSCGATA-4-exosome) can promote the differentiation of BMSC into cardiomyocyte-like cells, thereby improve cardiac function after myocardial infarction. However, the molecular mechanism of BMSCGATA-4-exosome in cardiomyocyte-like cell differentiation is unknown. The effect of the secretion of BMSCGATA-4 exosome from bone marrow mesenchymal stem cells (BMSC) in the differentiation of stem cells into cardiomyocytes was determined in miRNA-673-5p/Tsc-1 axis dependent manner.MethodsMouse models of myocardial infarction were established and divided into seven groups. Simulation group (BMSCmiR-673-5p-mimic exosome), inhibition group (BMSCmiR-673-5p-inhibitor exosome), GATA-4 group (BMSCGATA-4 exosome), empty vector group (BMSCempty vector exosome）, and BMSC group (BMSC exosome) were injected into the tail vein for 48 h, and the untreated and normal mice were used as the control group. Cardiac ultrasound was used to detect cardiac function in each group. miRNA-673-5p expression in myocardial infarction was detected using real-time polymerase chain reaction (RT-PCR). The myocardial tissues were extracted from the same myocardial infarction site. Myocardial-specific molecules, such as α-actin, Desmin, cTnT, and Cx43, were detected using RT-PCR. Western blot was used to determine the expression of the corresponding target gene of miRNA-673-5p, Tsc-1, Erk1/2, and Mef2c proteins.ResultsThe simulation group wan shown the most significantly improved myocardial function (P<0.05) with an expression peak of miRNA-673-5p in cardiomyocytes (P<0.05). The highest content of myocardial-specific molecules including α-actin, Desmin, cTnT, and Cx43 was found in the simulation group. The simulation group had the lowest expression of Tsc-1 in cardiomyocytes (P<0.05).ConclusionOverexpressed BMSCGATA-4 exosomes inhibit Tsc-1 expression through miRNA-673-5p to improve cardiac function during myocardial infarction.

Objective To explore the risk factors of recurrent low hemoglobin(RLH) level among students from 6 to 13 years old, and to formulate strategies and policies in this regard. Methods Surveillance on hemoglobin concentration was conducted among 71 742 students aged from 6 to 13y between 2013-2014 based on the annual physical examination for primary and middle school in Minhang District.Of those students, 670 were diagnosed with low hemoglobin level according to WHO criteria.A 1 ︰ 1 matched case-control study was conducted based on gender, age and school type.Questionnaire surveys for data collection were analyzed using Cox′s proportional hazards regression. Results Factors as pregnancy anemia(OR=2.32, 95%CI:1.49-3.63), non-pregnancy anemia(OR=4.65, 95%CI:1.22-17.69), maternal anemia(OR=2.51, 95%CI:1.50-4.21), drinking strong tea(OR=2.56, 95%CI:1.27-5.13) and dietary bias(OR=1.94, 95%CI:1.45-2.59) were risk factors of recurrent low hemoglobin level.Chewing pencils(OR=1.80, 95%CI:1.25-2.59) or toys(OR=1.79, 95%CI:1.10-2.86) and wasting(OR=3.37, 95%CI:1.11-10.21)might be the risk factors. Conclusion The risk factors of recurrent low hemoglobin level among students aged from 6 to 13 years are related to maternal anemia status and their dietary habits.We should strengthen education for women of child-bearing age, and help to develop healthy eating practices for their babies.Emaciated students should be focused on in this regard.

Objective To analyze malnutrition epidemiologic trend among students aged 6-18 years from 2010 to 2016 in Minhang district of Shanghai,and to provide reference for malnutrition prevention and treatment.Methods Physical examination data from healthy monitoring schools in Minhang District from 2010 to 2016 were used to screened out the malnutrition of students aged 6-18 years via National standard 2014 and analyzed the different type of malnutrition in different population.Results During the period of 2010 to 2016,malnutrition rate of students demonstrated a fluctuated trend.Malnutrition rate in 2010 was 4.0％ and 4.4％ in 2016.The major type of malnutrition is wasting with a proportion more than 88％ during these years.Rate of wasting increased from 3.5％ to 7.8％ in boys aged 13-18 years old and from 1.3％ to 3.9％ in girls aged 13-18 years old.Conclusions The malnutrition of students in Minhang District is under control,while the screening rate of wasting increased in students aged 13-18 years old.Intensified intervention of prevention and treatment should be administrated and integrated with obesity control in Minhang District of Shanghai.

Objective To analyze the epidemic features of anemia among students aged 6-11 years old in Minghang District,to provide basis for the control and prevention strategies of anemia among school students.Methods Surveillance on hemoglobin concentration was conducted among 42 872 students aged from 6 to 11 years old between 2012 and 2015.All data analyses were completed by SPSS 18.0 statistical software.Results The prevalence rate of anemia among school students 6-11 years old was 5.05％ (95％CI:4.84-5.26).The prevalence rate of anemia among girls was 5.28％,which was significantly higher than that 4.84％ among boys (x2 =4.24,P =0.037).Six-year-old boys and girls were most susceptible to anemia.Compared to students in Hope Schools,public school students are more vulnerable to anemia (boys:OR =2.37,95 ％ CI:2.03-2.76;girls:OR =2.08,95 ％ CI:1.74 -2.49).Overweight and obese students had a lower risk of anemia than average students (boys:OR =0.65,95 ％ CI:0.55-0.76;girls:OR =0.75,95 ％ CI:0.61-0.92).The three-year cumulative incidence of anemia was 12.80％ (95 ％CI:12.49-13.12).The cumulative incidence among girls was 14.52％,which was significantly higher than that of 11.28％ among boys (x2 =100.26,P＜0.001).Six-year-old boys have the highest three-year cumulative risk among all students,while 10-11-year-old girls have the highest three-year cumulative incidence.The risk of anemia in Hope School was found highest in all schools (boys:RR =1.93,95％CI:1.72-2.16;girls:RR =1.20,95 ％CI:1.04-1.39).Overweight and obesity were considered protective factors to anemia (boys:RR =0.75,95％CI:0.67-0.84;girls:RR =0.77,95％CI:0.68-0.88).The primary and recurrent detection rates of anemia were 14.58％ and 2.54％.The anemia among students was mainly detected during the first examination despite the differences in ages,schools and nutrition conditions (P ＜ 0.05).Conclusions The prevalence of anemia among primary school students in Minhang District is at a mild level.Control measures should be adopted,including monitoring of hemoglobin in all school children and adolescents,taking individual intervention measures based on results,promoting the health education for adolescent girls and parents of school children,and paying special attention to Hope School and students with recurrent and continuous anemia.

Objective To investigate the relationship between eating habits and childhood obesity by the method of cross-sectional survey in order to provide scientific basis for the prevention and intervention of childhood obesity.Methods We enrolled first-year students in Minhang District of Shanghai who participated in physical examination in 2014.Information was obtained from standardized face to face interviews of their parents or guardians with detailed questions on demographic characteristics,dietary habit,food preference,physical activity,sleep time and so on.Odds ratio (OR) and 95％ CI were calculated by unconditional Logistic regression models.Results Finally,5 752 students were enrolled in the study.The rate of obesity was 15.16％ (boys:18.35％;girls:11.83％) and the rate of over weight was 14.31％ (boys.:15.15％;girls:13.43％).Meat-based diet (OR=1.58,95％ CI:1.32-1.91),skipping breakfast (OR =1.87,95％ CI:1.01-3.46),eating too much caffeine-containing food (OR =1.66,95％ CI:1.09-2.51) and eating fast (OR:3.32-14.95) were associated with an increased risk of childhood obesity.Plant-based diet (OR =0.51,95％ CI:0.35-0.74) and choosy in food (OR:0.38-0.64) were associated with a decreased risk of childhood obesity.Besides,we found that children who preferred meat (OR =2.11,95％CI:1.42-3.14) and cured food (OR =1.42,95％ CI:1.05-1.92) had a higher risk of obesity.Conclusions Our results support the association between eating habits and childhood obesity.